Community Psychiatry Department, Institute of Mental Health, 10 Buangkok View, Singapore 539747.
Ann Acad Med Singap. 2013 Mar;42(3):125-32.
Assertive Community Treatment (ACT) was introduced in the 1970s as a comprehensive and assertive approach to community-based case management of patients with chronic and serious mental illness. Launched in Singapore in 2003, the Assertive Community Management (ACM) was modelled after the ACT, but with the main difference of 24 hour availability for the latter only. In line with the move towards de-institutionalisation of psychiatric patients, ACM was introduced to provide a mobile community-based multidisciplinary team approach to manage patients with severe chronic psychiatric illness. This article aims to evaluate and provide an update on this service programme in Singapore following an earlier study by Fam Johnson in 2007.
A naturalistic and retrospective study was conducted. One hundred and fifty-five patients recruited into ACM from 1 September 2008 to 1 September 2009 and had completed 1 year of ACM were included in our study. Outcomes were defined as number of admissions (NOA) and length of stay (LOS) one year before and one year following induction into the programme. Baseline socio-demographic factors were also investigated to see if they predicted outcome with ACM.
The mean NOA was 1.9 pre-ACM and 0.6 post-ACM, with mean reduction in NOA of 1.3 (P <0.01). The mean LOS was 72.2 days pre-ACM and 17.1 days post ACM, mean reduction in LOS 55.1 days (P <0.01). In addition, it was found that gender, diagnoses and ethnicity were not predictive of the outcome measures of NOA or LOS.
ACM in Singapore had been well established since its inception and continued to show effectiveness in reducing inpatient hospitalisation among the chronically mentally ill.
主张性社区治疗（ACT）于 20 世纪 70 年代作为一种综合而坚定的方法引入，用于对慢性和严重精神疾病患者进行基于社区的病例管理。2003 年在新加坡推出的主张性社区管理（ACM）是在 ACT 的基础上建模的，但主要区别在于后者 24 小时可用。为了配合将精神科患者从机构中解放出来的趋势，引入 ACM 是为了提供一种移动的基于社区的多学科团队方法，以管理患有严重慢性精神疾病的患者。本文旨在对 Fam Johnson 于 2007 年进行的早期研究后，对新加坡的这项服务计划进行评估和更新。
进行了自然主义和回顾性研究。从 2008 年 9 月 1 日至 2009 年 9 月 1 日，我们将 155 名患者纳入 ACM，这些患者在入组 ACM 后完成了 1 年的治疗。结果定义为入组前 1 年和入组后 1 年的入院次数（NOA）和住院时间（LOS）。还调查了基线社会人口统计学因素，以观察它们是否与 ACM 的结果相关。
入组前的平均 NOA 为 1.9，入组后的平均 NOA 为 0.6，NOA 平均减少 1.3（P <0.01）。入组前的平均 LOS 为 72.2 天，入组后的平均 LOS 为 17.1 天，LOS 平均减少 55.1 天（P <0.01）。此外，发现性别、诊断和种族并不是 NOA 或 LOS 结果测量的预测因素。
自成立以来，新加坡的 ACM 已经得到很好的建立，并继续在减少慢性精神病患者的住院治疗方面显示出有效性。
